Analgesics

Question 1

Four processes of pain

Answer 1

Transduction - activation of nerve endings
Transmission - synapsing with next neuron
Perception - brain receives
Modulation - changing perception for next time

Question 2

Neuropathic pain
Defined
Causes
Examples

Answer 2

injury to sensory system
caused by nerve injury
allodynia, hyperalgesia

Question 3

What type of pain is cancer associated with?

Answer 3

Breakthrough

Question 4

Analgesics vs anesthetics

Answer 4

analgesics block sensation of pain without blocking other symptoms or loss of consciousness

anesthetics block nerve conduction and can cause loss of consciousness

Question 5

Opioids sites of action (2)

and what kinds of receptors?

Answer 5

perception at the brain level

modulation - reduce neurotransmitter release from neurons in the spinal cord

mu opioid receptors on nerve cells (in the brain and spinal cord)

Question 6

Endogenous opioids

Answer 6

Endorphins and enkephalins

Question 7

Most common type of opioid receptor in brain

Answer 7

Mu receptors

Question 8

Consider the 13 Pharmacological Properties of Opioids

Answer 8

Pharmacological Properties of Opioids

ANALGESIA

SEDATION and `MENTAL CLOUDING‘

EUPHORIA and TRANQUILLITY

ANTITUSSIVE - depresses cough

DEPRESSION OF RESPIRATORY CENTRE

NAUSEA, VOMITING

MIOSIS (PIN POINT PUPIL)

TOLERANCE AND SERIOUS DEPENDENCE

CONSTIPATION

POSTURAL HYPOTENSION

DILATION OF CUTANEOUS BLOOD VESSELS (WARM SKIN)

URINARY URGENCY BUT DIFFICULTY IN URINATION

Question 9

Name 3 opioids
Indications:
Metabolism:
Contraindications (4):
Adverse Effects (4): 
Interactions: 
Implications:

Answer 9

morphine “the standard”
codeine
oxycodone

Indications: primarily alleviate pain. also cough, diarrhea

Metabolism: half life is 2-4 hours. extensive first pass metabolism

Contraindications: liver dysfunction, respiratory distress, pregnancy, increased ICP

Adverse Effects (4): respiratory depression, CNS depression, nausea/vomiting, constipation

Interactions: CNS depressants (sedatives, alcohol)

Implications: Take with food, adequate fluid and fiber intake necessary

Question 10

WHO Pain management ladder 3 levels

Answer 10

1 - non opioid and adjuvant
2 - opioid for mild/moderate + non opioid + adjuvant
3 - opioid for moderate/severe + non opioid + adjuvant

Question 11

The most common non-narcotic analgesics?

Answer 11

NSAIDs

Question 12

Adjuvants (3)

Answer 12

antidepressants
antiseizure
glucocorticoids

Question 13

How does the liver alter codeine?

Answer 13

Converts it to morphine (depends on ability of liver to produce conversion enzymes)

Question 14

Opioid antagonist
Half life (compared to morphine)

Answer 14

Naloxone
used for reversal of respiratory depression
Shorter half-life of 1-2 hours (it wears off before morphine)